Citation Nr: 0309590
Decision Date: 05/22/03 Archive Date: 05/27/03
DOCKET NO. 01-08 433A ) DATE
)
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On appeal from the
Department of Veterans Affairs Regional Office in Winston-
Salem, North Carolina
THE ISSUE
Entitlement to service connection for the cause of the
veteran's death.
REPRESENTATION
Appellant represented by: Jeff Schwartz, Attorney
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
Siobhan Brogdon, Counsel
INTRODUCTION
The veteran served on active duty from March 1950 until March
1953. He died on November [redacted]
, 1999. The appellant is the
widow of the veteran.
This appeal comes before the Department of Veterans Affairs
(VA) Board of Veterans' Appeals (Board) from a December 1999
rating decision of the Winston-Salem, North Carolina Regional
Office (RO) which denied service connection for the cause of
the veteran's death.
The appellant was afforded a videoconference personal hearing
in September 2002 before a Member of the Board sitting at
Washington, DC; the transcript of which is of record.
REMAND
The veteran's death certificate notes that he died in
November 1999 of cardiac arrest, due to or as a consequence
of ventricular fibrillation, due to or as a consequence of
coronary artery disease. An autopsy was not performed and no
other contributory cause of death was recorded. The
appellant and her representatives assert, however, that the
veteran's service-connected residuals of frostbite of the
hands and feet were so severe, and aggravated the veteran's
circulatory system to such an extent, that it materially and
substantially contributed to the cause of death, for which
service connection should be granted.
A review of the record discloses that there is a medical
opinion of record which supports a relationship between the
veteran's service-connected cold injury residuals and a
worsening of his coronary artery disease, as well as others
which tend to indicate that cold injury residuals played a
role in the development of diabetes which led to
cardiovascular disability leading to death. The Board finds,
however, that most of the supporting evidence in this regard
is vague and conclusory, and does not provide the requisite
degree of discussion and rationale for the opinions
expressed. Therefore, it is found that further review of the
evidence and opinion by a board-certified specialist is
indicated. The fulfillment of the VA's statutory duty to
assist the appellant includes providing additional VA
examination by a specialist when indicated, and providing a
medical opinion, which takes into account the records of
prior medical treatment, so that the disability evaluation
will be a fully informed one. See Hyder v. Derwinski, 1
Vet.App. 221 (1991); Green v. Derwinski, 1 Vet.App. 121, 124
(1991).
Accordingly, this case is REMANDED to the RO for the
following action:
The veteran's claims folder and a copy
of this remand should be referred to a
board-certified cardiovascular
specialist for review and opinion as to
the nature and etiology of the
cardiovascular disease shown to be the
cause of death on the veteran's death
certificate. Based on a review of all
pertinent medical documentation and
history on file, the examiner is
requested to provide opinions as to as
to whether it is at least as likely as
not 1) that there was any etiological
relationship between the cardiovascular
disease from which the veteran died and
his service-connected residuals of
frostbite of the hands and feet on a
secondary basis 2) that the veteran's
cardiovascular disability was
"aggravated" (or permanently worsened)
by the frostbite residuals to the extent
that the service-connected disability
materially or substantially contributed
to the cause of the veteran's death in
any way (If aggravation is found, the
examiner should offer an assessment of
the extent of additional disability
resulting from the aggravation of the
cardiovascular disorder), and 3) whether
the service-connected frostbite
residuals were materially or
substantially implicated in the
development or aggravation of diabetes
which predisposed the veteran to
coronary artery disease. The examiner
should reconcile his/her opinions with
any conflicting medical assessments and
opinions in the record. The examination
report should set forth in a clear,
comprehensive, and legible manner all
pertinent findings, and should include
complete rationale for the opinions
expressed in a typewritten report.
The appellant has the right to submit additional evidence and
argument on the matter or matters the Board has remanded to
the regional office. Kutscherousky v. West, 12 Vet. App. 369
(1999).
This claim must be afforded expeditious treatment by the RO.
The law requires that all claims that are remanded by the
Board of Veterans' Appeals or by the United States Court of
Appeals for Veterans Claims for additional development or
other appropriate action must be handled in an expeditious
manner. See The Veterans' Benefits Improvements Act of 1994,
Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994),
38 U.S.C.A. § 5101 (West 2002) (Historical and Statutory
Notes). In addition, VBA's Adjudication Procedure Manual,
M21-1, Part IV, directs the ROs to provide expeditious
handling of all cases that have been remanded by the Board
and the Court. See M21-1, Part IV, paras. 8.44-8.45 and
38.02-38.03.
_________________________________________________
LAWRENCE M. SULLIVAN
Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Appeals for Veterans Claims. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (2002).